Malignancy Waiver

Consent Agreement Concerning Scope of Practice, Nutritional Therapy and Supportive Cancer Care

To Whom It May Concern:

The Richards Family Health Center offers supportive (adjunctive) care for patients with malignant disease.

We wish to emphasize that supportive care given here is not offered as a primary treatment for cancer. It is not intended to replace standard medical care of surgery, radiation, and/or chemotherapy. It is the conventional medical view that untreated cancer is a progressive disease which, in the great majority of instances, ends in death.

The patient coming to our clinic for supportive care should be aware that conventional medical therapies are highly effective in bringing cure and/or prolonged remissions for certain types and stages of malignancies. Some examples are:

Non-melanomatous skin cancers: In their early stages, the cure rates approach 100%.

Stage I (localized) breast cancer: Surgery and/or radiation brings cure rates of approximately 90%.

Hodgkins disease: In early or limited disease the cure rates approach 90%. With more advanced stages the cure rates are somewhat reduced, but still favorable for cure or remission.

Seminoma (testicular cell cancer): This form of cancer is highly curable with chemotherapy. Even in disseminated disease the cure rate is over 50%.

Since a nutritional deficiency may or may not be associated with a specific disease, or it may be the cause of the disease, or it may occur as a result of that disease, it is important for you to understand fully that our sole concern in your case will be your nutritional program and your ability to metabolize and utilize the nutrients you consume.

We will not diagnose, treat or cure any specific disease and the nutritional recommendations we make based on laboratory tests, physical and clinical findings, history and symptoms, does not constitute treatment for any disease or affliction real or imagined by you. In addition, we specifically do not treat the disease of cancer. If you desire treatment for malignancy (cancer), you should place yourself at the disposal of another doctor who employs the only recognized cancer treatment procedures in the United States which consist of: surgery, chemotherapy, high energy radiation and/or hormone therapy.

For all patients with malignant disease coming to our clinic for supportive care, we urge them to continue with regular, ongoing visits to an appropriate medical specialist (surgeon, radiologist, and/or oncologist). For those patients with potentially curable malignancy (curable by conventional means), such visits are required as a condition for acceptance for our care.

In the nutritional management of a case, we routinely prescribe numerous vitamins, minerals, and enzymes and we do not want you to have any misconceptions about their use in the this clinic. In the event that any vitamin, mineral, food or physical therapy device is prescribed or administered in your case, we want you to understand explicitly that its purpose will be for:

(1) The improvement of your overall nutritional status

(2) To improve your metabolism

(3) For improvement of the sense of well-being

(4) To improve appetite

(5) For gain or reduction in weight

(6) For possible remission or reduction of pain where present.

However, you must understand that you may not receive any of these benefits because they do not occur predictably with every patient; and in some cases they may not occur at all.

Before you sign this agreement, we want you to understand that our viewpoint concerning NUTRITION and the need for certain nutrients is not necessarily shared by the American Medical Association, the Food and Drug Administration and the American Cancer Society, or other similar agency or organization.

If you sign this agreement you will be signifying that you disagree with these organizations insofar as their opinion differs with ours concerning NUTRITION and that you desire to have prescribed and administered in your case such vitamins, minerals, enzymes or devices which, in our professional opinion, appear to be indicated for your nutritional need.


I HAVE READ AND UNDERSTAND THE ABOVE. Under the conditions indicated, I hereby place myself under your care for such advice, prescriptions and administrations as may appear to be indicated in your professional judgment. I will secure the services of another doctor for treatment of specific disease entities and will look to you only for nutritional counsel and management.

Patient:_______________________ Date:_____________


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